Ashley Morgan

Does Your Practice Have a Compliance Officer or Compliance Committee?

Medicare, Medicaid & Private Payor Updates /

(October 29, 2015): Last month we discussed why having a functioning, effective compliance program is important. If done correctly, a compliance program that is functional, effective, and well-documented is as important as your medical malpractice liability insurance. Indeed, the Affordable Care Act now requires compliance programs and many private payers now explicitly require compliance programs […]

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CMS Issues New Instructions to its Contractors Regarding the Scope of Claim Appeals

Medicare, Medicaid & Private Payor Updates /

(October 15, 2015): In an effort to stem the ever-increasing tide of claim appeals, CMS recently issued new guidance (MLN Matters SE1521) to its Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the conduct of requests for redetermination and reconsideration, respectively. Effective 08/01/15, MACs and QICs may no longer review claims denied during

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Structural Denial of Due Process in HCQIA Peer Review Proceedings

Medicare, Medicaid & Private Payor Updates /

(October 12, 2015): The Federal HCQIA peer review statute affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. These due process rights are expressed as a right to a hearing, and are

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How to Implement a Compliance Plan in Your Practice

Medicare, Medicaid & Private Payor Updates /

(September 17, 2015): Despite the fact that Medicare and Medicaid requires that participating providers implement a compliance plan, most small providers have yet to complete the necessary steps to accomplish this requirement.  “My office manager went to a continuing education program, and she’s come back telling me we need a compliance program. I don’t know about

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Cell Tower Ground Lease Renewals and Purchases

Regulatory Issues | Privacy | Other /

(September 15, 2015): A landowner/ground lessor considering a renewal or easement buyout of his cell tower lease is making a MAJOR financial decision. As a businessman (or woman), you understand that. You may also realize that information about what’s “market rent” or “market price” is hard to come by. Your operator is likely one of

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CMS Awards Zone 6 ZPIC Contract to SafeGuard Services

Medicare, Medicaid & Private Payor Updates /

(August 15, 2015): The Centers for Medicare and Medicaid Services (CMS) has awarded the contract for Zone Program Integrity Contractor (ZPIC) services for Zone 6 to SafeGuard Services, LLC. Zone 6 encompasses Maryland, Delaware, Washington, D.C., Pennsylvania, New Jersey, New York, Connecticut, Massachusetts, Rhode Island, Vermont, New Hampshire, and Maine. SafeGuard is the current program

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Challenging Medicaid Underpayments: Impact of the Armstrong Case

Medicare, Medicaid & Private Payor Updates /

This article is reprinted with permission from the June 2015 edition of the American Health Lawyer Association Journal of Health and Life Sciences Law, volume 8, number 3 at page 3. The Journal has an online order link here for anyone who wishes to subscribe. (July 8, 2015): On March 31, 2015, the United States

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Liles Parker’s Michael Cook Appointed to Virginia Board of Medical Assistance Services

Firm News /

(March 20. 2015): Liles Parker is proud to announce that Governor Terry McAuliffe (VA) has appointed Michael Cook, co-chair of our health care group, to a four-year term as a member of the Virginia Board of Medical Assistance Services. The Board is established pursuant to Virginia statute to oversee the Medicaid program, including the development

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Individual Liability for Medicare Overpayment Claims

Medicare, Medicaid & Private Payor Updates /

(February 24, 2015): Medicare recently finalized regulations allowing enrollment as a Medicare provider to be denied if any owner or control person of the enrolling provider is affiliated with another provider which owes money to Medicare. These regulations are based on sections of the 2010 Affordable Care Act (ACA). They provide CMS an indirect means

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